You Might Also Like: ZOE Science & Nutrition

Summary

Podcast Summary: You Might Also Like: ZOE Science & Nutrition

Podcast Information:

• Title: You Might Also Like: ZOE Science & Nutrition
• Host: Jonathan Wolf
• Guest: Dr. Will Bolsiewicz
• Release Date: November 19, 2024
• Description: In this episode of Zoe Shorts, host Jonathan Wolf delves into the intricacies of Irritable Bowel Syndrome (IBS) with gastroenterologist Dr. Will Bolsiewicz. The discussion covers the nature of IBS, its symptoms, diagnosis, the connection between stress and gut health, and various management strategies.

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1. Introduction to IBS

The episode begins with a brief advertisement from Zoe about their Cyber Week discount on personalized nutrition programs. Following the ad, Jonathan Wolf welcomes Dr. Will Bolsiewicz to discuss Irritable Bowel Syndrome (IBS).

Notable Quote:

• Dr. Will Bolsiewicz [00:48]: "IBS is more common than you might think, but still very misunderstood."

2. Historical Perspective

Dr. Bolsiewicz takes listeners back to the late 1800s, highlighting the origins of the term "Irritable Bowel Syndrome." He credits Sir William Osler with coining the term "mucous colitis" in 1892, which laid the foundation for the modern understanding of IBS.

Notable Quote:

• Dr. Will Bolsiewicz [01:28]: "He coined the term mucous colitis, which is the early definition of irritable bowel syndrome."

3. Understanding IBS Today

IBS is characterized as a collection of symptoms rather than a single disease. The core symptom is abdominal pain, which accompanies changes in bowel movements such as diarrhea, constipation, or a mix of both. While IBS is chronic and manageable, it does not increase the risk of more severe bowel diseases.

Notable Quote:

• Dr. Will Bolsiewicz [02:26]: "IBS is a group of symptoms that happen together... it's something you can manage to the point that it doesn't necessarily affect your quality of life."

4. Prevalence and Demographics

IBS affects approximately 10% of the global population, with higher prevalence in North America (10-15%). It is more common in women and less prevalent in individuals over 50 years old. Jonathan Wolf shares his personal experience with mild IBS in his younger years.

Notable Quote:

• Jonathan Wolf [03:16]: "IBS affects about one in 10 people worldwide... more likely to affect women than men."

5. Symptoms and Diagnosis

Abdominal pain is essential for an IBS diagnosis. Symptoms vary widely, including sharp pain, cramping, bloating, or burning sensations. Other symptoms may include stomach gurgling, incomplete bowel movements, and mucus in stool.

Notable Quote:

• Dr. Will Bolsiewicz [04:07]: "Abdominal pain is a core part of this diagnosis. If you don't experience any abdominal pain or discomfort, then it's not IBS."

Diagnostic Criteria: Diagnosis relies on pattern-based criteria known as the ROAM criteria (currently in its fourth iteration). Patients must experience recurrent abdominal pain at least once a week over the past three months, accompanied by at least two specific changes in bowel movements.

Notable Quote:

• Dr. Will Bolsiewicz [06:05]: "To diagnose IBS, you have to fulfill specific pattern-based criteria... the ROAM four criteria."

6. Types of IBS

IBS is classified into four types based on predominant symptoms:

• IBS-D: Diarrhea
• IBS-C: Constipation
• IBS-M: Mixed (both diarrhea and constipation)
• IBS-U: Unclassified

Notable Quote:

• Dr. Will Bolsiewicz [07:09]: "There's IBS-D for diarrhea, IBS-C for constipation, IBS-M for mixed, and IBS-U for unclassified."

7. Differential Diagnosis

It is crucial to rule out other conditions that mimic IBS symptoms to ensure appropriate treatment. Red flag symptoms such as unexplained weight loss, anemia, blood in stool, nocturnal diarrhea, and progressive abdominal pain warrant further investigation for conditions like celiac disease, inflammatory bowel disease (IBD), chronic infections, and food intolerances.

Notable Quote:

• Dr. Will Bolsiewicz [08:07]: "Red flag symptoms include unexplained weight loss, anemia, seeing blood in the stool... to ensure it's not something more serious."

8. The Gut-Brain Connection

The interplay between stress, anxiety, and IB symptoms is significant. Studies indicate that individuals with IBS often report higher levels of stress and anxiety, and these psychological factors can both influence and be influenced by gut health.

Notable Quotes:

• Dr. Will Bolsiewicz [12:17]: "There is very clearly a psychological element to IBS."
• Dr. Will Bolsiewicz [15:26]: "These things are very much interconnected. It's hard to separate them."

9. Management and Treatment Strategies

Managing IBS requires an individualized approach, encompassing dietary modifications, supplements, lifestyle changes, and sometimes medications.

Dietary Changes:

• Elimination of Trigger Foods: Reducing caffeine, alcohol, spicy, and fatty foods can alleviate symptoms.
• Low FODMAP Diet: Temporarily restricting fermentable sugars like lactose, fructose, and certain fibers can help identify trigger foods.

Supplements:

• Peppermint Oil: Helps relieve abdominal discomfort and bloating.
• Probiotics: May improve symptoms, though effectiveness varies.
• Fiber Supplements: Soluble fibers like psyllium husk can be beneficial.

Alternative Therapies:

• Acupuncture: Clinical trials suggest it can improve IBS symptoms.
• Mindfulness and Cognitive Behavioral Therapy (CBT): Effective in managing stress and anxiety related to IBS.

Medications:

• Repurposed medications originally developed for depression are used at lower doses to treat IBS symptoms effectively.

Notable Quotes:

• Dr. Will Bolsiewicz [16:34]: "Cut out caffeine, alcohol, and spicy and fatty foods."
• Dr. Will Bolsiewicz [17:02]: "FODMAP stands for fermentable ligosaccharides, disaccharides, monosaccharides, and polyols... temporarily reduce these foods."

10. Addressing Persistent Symptoms

For patients not responding to standard treatments, it's essential to reassess the diagnosis to rule out other underlying conditions. Additionally, focusing on the gut microbiome's health is paramount, as it plays a central role in IBS development.

Notable Quote:

• Dr. Will Bolsiewicz [20:38]: "Our solution should include centrally a focus on improving and elevating the gut microbiome."

11. Conclusion

Dr. Bolsiewicz emphasizes that IBS is not merely a psychological issue but a complex interplay between the gut and the brain. Effective management requires a comprehensive approach that includes dietary changes, supplements, psychological therapies, and, when necessary, medications. He underscores the importance of not dismissing IBS as "all in your head" but recognizing the tangible physiological and psychological factors involved.

Notable Quote:

• Dr. Will Bolsiewicz [21:25]: "Absolutely not. There's a brain-gut connection that is really relevant to IBS. We should not lose sight of these other things that can be beneficial."

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Key Takeaways:

• IBS is a chronic condition characterized by abdominal pain and changes in bowel habits.
• Diagnosis relies on symptom patterns rather than specific tests, using criteria like the ROAM criteria.
• Management is multifaceted, involving dietary changes, supplements, alternative therapies, and sometimes medications.
• The gut-brain axis plays a significant role in IBS, highlighting the need for a holistic treatment approach.
• Individualized treatment plans are essential, as IBS manifestations and triggers vary among patients.

Additional Resources: For listeners interested in personalized nutrition programs to manage IBS and overall gut health, Zoe offers a specialized membership with advanced gut health testing. Currently, there is a Cyber Week discount available until December 3rd.

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This summary provides a comprehensive overview of the podcast episode, capturing the key discussions and insights shared by Jonathan Wolf and Dr. Will Bolsiewicz on Irritable Bowel Syndrome.

Transcript

[Zoe]

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[Jonathan Wolf]

Hello and welcome to Zoe Shorts, the bite sized podcast where we discuss one topic around science and nutrition. I'm Jonathan Wolf and today I'm joined by Dr. Will Bolsiewicz. And today's subject is irritable bowel syndrome.

[Dr. Will Bolsiewicz]

IBS. Jonathan, it's more common than you might think, but still very misunderstood.

[Jonathan Wolf]

Why is it so common? Well, and yet no one seems to really understand what it is. In fact, what is it exactly? And how is it different from bowel diseases?

[Dr. Will Bolsiewicz]

Those questions are complicated to answer. As it turns out, there's a mysterious mind body connection when it comes to irritable bowel syndrome.

[Jonathan Wolf]

Intriguing. Let's get into it.

[Dr. Will Bolsiewicz]

Okay, Jonathan, let's jump in our DeLorean for a moment. And we're going to travel back to, of all places, a medical school in the late 1800s.

[Jonathan Wolf]

Why?

[Dr. Will Bolsiewicz]

That's when IBS was first discovered. It was a Canadian physician, a very famous physician, someone who I learned about in medical school. His name is Sir William Osler. If you could just picture a big white mustache and a pocket watch, that's kind of the imagery that we have. So he was one of the best known physicians at the time. And in 1892, he coined the term mucous colitis. And what he was referring to was a digestive condition that involved a combination of abdominal colic or abdominal pain and the passing of mucus in the stool. And today this has been recognized as being the early definition of irritable bowel syndrome.

[Jonathan Wolf]

And I guess the fact that it was so long ago explains why this name, irritable bowel syndrome, sounds a bit like an 80s rock band. I'm assuming that since then we've learned a lot, Will. So what exactly do we think IBS is today?

[Dr. Will Bolsiewicz]

It's a group of symptoms that happen together. And so basically you have to start with having abdominal pain and that abdominal pain will occur alongside some sort of change in the bowels. So it could be diarrhea, constipation, or a combination of both. Now, the symptoms of IBS may change over time, but IBS is often lifelong. This is not something that you can just cure with antibiotics or something like that, but it's something that you can manage. It's something you can manage to the point that it doesn't necessarily affect your quality of life. IBS is interesting because although it's a bowel disease, it doesn't increase your risk of developing bowel cancer or other bowel related issues. The mystery around IBS is that even though this is so common, we don't know exactly what causes it. Although I will say we have some strong clues that we'll talk about today.

[Jonathan Wolf]

And Will, it's really common, Right? So we looked at the latest data and IBs affects about one in 10 people worldwide. In North America, it's estimated that 10 to 15% of the population have it. It's less prevalent in people aged over 50, and it's also more likely to affect women than men. And as some listeners may know, I suffered from fairly mild IBS in my 20s and into my 30s. So it's something that I have personal experience with and is quite close to my heart. So can we start, Will, by looking at some of those classic IBS symptoms? And I think that those often consist of sort of this stomach pain combined with a sort of change in bowel movements. In other words, not sort of the regular movement that, you know, we all would like to be having when we go to the toilet.

[Dr. Will Bolsiewicz]

Yeah, that's exactly right. And I think we have to start by saying that abdominal pain is a core part of this diagnosis. So if you don't experience any abdominal pain or discomfort, then it's not ibs. Although you may still be experiencing diarrhea or constipation, it can come with different experiences for different patients. So, for example, some may experience a discomfort or pain that's sharp and intense. Others have these cramps that sort of seem to come in waves, like it builds up and then relieves. Or others have symptoms more like bloating or even a burning discomfort. So individuals with ibs, they can have other coinciding symptoms like gurgling of the stomach or the feeling of incompletely evacuating their bowels after a bowel movement or even the passage of mucus in the stool, which is what Dr. Ossler was referring to.

[Jonathan Wolf]

So, Will, I mean, none of these things sound like fun. And we've also discussed a lot of different digestive health issues on the show, and some of those symptoms overlap with some of the things you were just describing. So if A listener is listening to this right now. How can you tell if these symptoms add up to ibs? And could you maybe talk us through how it's normally diagnosed? Sure.

[Dr. Will Bolsiewicz]

So we have to start with the basics, which is that IBS is a pattern of symptoms and we call it irritable bowel syndrome. The word syndrome being really key there for a reason. And that's because we have to use criteria to diagnose ibs.

[Jonathan Wolf]

There's no specific blood test or X ray or poop test to diagnose ibs.

[Dr. Will Bolsiewicz]

This is actually the key in a way, Jonathan, which is, is that there's no definitive test. So ultimately, in order to diagnose ibs, you have to fulfill specific pattern based criteria. And the criteria that we use are called the roam criteria. Now, this has been revised. It started with roam one, now we're up to roam four. So this is the fourth version.

[Jonathan Wolf]

What does the roam four criteria then say?

[Dr. Will Bolsiewicz]

Okay, so in order to qualify under the criteria, you need to have first recurrent abdominal pain at least one day per week in the last three months. And then in addition to that, you need to have at least two specific changes that relate to your bowel movements. One is that there's an association of your symptoms with your bowel movement. For the majority of people who have ibs, Jonathan, they will experience improvement of their symptoms after they go to the loop. A second possibility is a change in the stool frequency, and then the third is change in stool appearance. So basically changes with the bowel movements, changes in stool frequency, changes in stool appearance. You need at least two of those.

[Jonathan Wolf]

And are there different types of ibs?

[Dr. Will Bolsiewicz]

Indeed there are. There's four types, actually. So IBS D stands for diarrhea, meaning that the abnormal bowel movements are usually diarrhea. Then we have IBS C. I think.

[Jonathan Wolf]

I can guess this one. I'm guessing this means constipation, right?

[Dr. Will Bolsiewicz]

That is correct. And then there's IBSM for mixed, which is of course a mix of both diarrhea and constipation. And then the last one, which is actually quite rare, but it's ibsu, which means unclassified. And these are patients who haven't met the technical criteria for IBS in terms of diarrhea or constipation. So they really can't be slotted into one of these other three types.

[Jonathan Wolf]

Got it. All right, so take me into the doctor's office, like your office, during one of these diagnoses.

[Dr. Will Bolsiewicz]

Well, so the first thing is that the clinician is going to start With a comprehensive history and physical examination. This is an opportunity for the patient to really describe these symptoms in full detail.

[Jonathan Wolf]

Now, pain, diarrhea, constipation, they're also symptoms of other conditions which you've talked about, will, on previous podcasts. So what's the risk of Ms. Misdiagnosing here?

[Dr. Will Bolsiewicz]

Yeah, that's. That's an excellent point, Jonathan, because, you know, one of the important things from my perspective as a medical doctor, is to make sure that you're not missing something else. There's a number of different conditions that can masquerade and sound just like ibs, and yet if it's something else, you're not. You're not treating your patient appropriately until you make that diagnosis and then target that in terms of your treatment. So one of the things that doctors will do is they'll look for red flag symptoms. And this helps the doctor to realize that there may be something more going on here beyond just run of the mill irritable bowel syndrome. The red flag symptoms include unexplained weight loss, anemia, seeing blood in the stool, having diarrhea in the middle of the night, having progressive and intensifying abdominal pain. And then we also get a little more cautious in people beyond age 50 or who have a family history of inflammatory bowel disease or bowel cancer, because in those cases, you just don't want to miss those possibilities.

[Jonathan Wolf]

And I know that in my case, and this is now almost 30 years ago, that the doctors did a lot of investigations to make sure that I didn't have any bowel diseases. And I remember it was an enormous relief to discover that it wasn't cancer, which I've been really scared of, Val, or some major bowel disease. Now, what are some of the alternatives to IBS today that a doctor might be looking for?

[Dr. Will Bolsiewicz]

So there's a number of possibilities. Of course, a doctor is going to individualize what they're doing to what the patient is reporting to them. But some of the ones that I would classically think about include chronic infections. So things like C. Diff infection or giardia. I always would have a very high level of suspicion for the possibility of celiac disease because it can sound just like ibs. You have to think about food intolerances. So it could be lactose intolerance. It could be a FODMAP intolerance or a sucrose intolerance. You could also have small intestine bacterial overgrowth. People know this as sibo. Or you could have an inflammatory bowel disease, which Includes conditions like ulcerative colitis, Crohn's disease, or something called microscopic colitis.

[Jonathan Wolf]

And could it in fact, be as simple as chronic constipation?

[Dr. Will Bolsiewicz]

It could. Uh, it's interesting because not everyone who has constipation has ibs, but everyone who has IBS C has constipation. And there are even several patterns of constipation that can masquerade as other forms of IBS.

[Jonathan Wolf]

Sneaky. So how does that work, Will?

[Dr. Will Bolsiewicz]

I'm specifically thinking about IBS D or even IBS M, the mixed IBS because I actually think in many cases, these are constipation. Let me give you a quick example, Jonathan. Someone could have zero bowel movements for several days in a row, and then all of a sudden, they have this one day where the first bowel movement comes and it's formed, but then they keep having more and more bowel movements as the day goes on. And the bowel movements, they get looser and looser to the point of being water. So this person, they think they have diarrhea, but it's. From my perspective, this is actually constipation.

[Jonathan Wolf]

So they're sort of backed up for days until they're sort of effectively set to explode.

[Dr. Will Bolsiewicz]

Yeah, to put it delicately, Jonathan.

[Jonathan Wolf]

Okay. Not a technical term. Okay. So, you know, maybe coming to my own experience, I was diagnosed with IBS in my early 20s. So a little more than 25 years ago, after I had been very sick with glandular fever, which is mononucleosis for you, Will, in the States for sort of six months. And at that time, you know, I remember this really well, none of the gastroenterologists that I saw thought that any of the microbes in our gut mattered at all. This is basically pre the time when the microbiome had been discovered. So at the time, they were basically convinced that IBS was probably largely caused by stress, and that basically, if you could get yourself really relaxed, then probably this would solve most of this problem. Is that a real thing still today, or is that a myth from a time before we understood the importance of our. Our gut bacteria and just sort of the complexity of what was going on inside our gut.

[Dr. Will Bolsiewicz]

When it comes to the connections between stress and the manifestations in our gut, there is very clearly a psychological element to ibs. In fact, Jonathan, one study found that patients with IBS reported more lifetime and daily stressful events than control groups.

[Jonathan Wolf]

That's interesting. And, Will, does this mean that stress is a cause or just a result of an unhappy gut? Because, again, thinking Back to when I had this. If you've got a really bad stomach and it may be impacting your quality of life, I mean, you're going to feel stressed as a result of this. Which way round is it?

[Dr. Will Bolsiewicz]

Looking at the data, stress has been linked to the onset of symptoms and then the symptoms improve when the stress is gone. So there's that. And another study found that patients with IBS showed increased levels of anxiety, depression and phobias. So I think that there's sort of a little bit of both going on here.

[Zoe]

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[Jonathan Wolf]

Which I have learned in everything to do with the human body is common. Right? It's never as simple as one thing. So the team who looked at this found a recent study, a very recent study from 2021 of over 50,000 people with IBS around the world. And the researchers in that study found that people with IBS were more likely to have anxiety. And when I think back to where my symptoms were really bad, which is sort of right at the beginning of my early 20s, I was definitely, you know, I mean, maybe not medically depressed by this, but definitely, you know, depressed by this in sort of common language. And I thought what was interesting is a study also found that people with both IBS and anxiety were more likely to have been treated frequently with antibiotics during childhood. And the study authors suggested that repeated use of antibiotics during childhood might increase the risk of IBS and Anxiety by altering the normal gut bacteria, which in turn influences nerve cell development and mood.

[Dr. Will Bolsiewicz]

The team was very careful, though, to say that this doesn't necessarily mean that anxiety causes IBS symptoms or vice versa. It's just that these things are very much interconnected. It's hard to separate them.

[Jonathan Wolf]

And I know one of the things I was amazed to discover is this huge amount of nerves and immune system control in our gut. Right. So actually the brain and the gut, they really are linked. It's not just one of those things that people say 100%. So, Will, we've gone over what IBS is, how it's diagnosed, the role that stress and anxiety might play. What about how to manage symptoms? If any of our listeners are saying, I think I do have IBS or indeed I've been diagnosed with it.

[Dr. Will Bolsiewicz]

So first of all, to those listeners, you have to understand treatment is always going to be individualized. So it's a little bit hard to completely generalize when IBS D and IBS C are sort of different things in terms of how you attack them. But there are some general rules that we can use, and that's what I wanted to address today. Some patients see improvement in their symptoms very quickly if they take these simple steps. Cut out caffeine, alcohol, and spicy and fatty foods.

[Jonathan Wolf]

That's funny. I remember being told very specifically to cut out broccoli.

[Dr. Will Bolsiewicz]

Well, that's discriminatory against broccoli. But nonetheless, there is also the concept of the low FODMAP diet, Jonathan, which is usually a secondary thing.

[Jonathan Wolf]

Tell us what a low FODMAP diet is.

[Dr. Will Bolsiewicz]

FODMAP is a very nerdy thing, standing for fermentable ligosaccharides, disaccharides, monosaccharides and polyols.

[Jonathan Wolf]

That's a real mouthful, if you'll excuse the pun.

[Dr. Will Bolsiewicz]

It basically means different types of sugar that the small intestine struggles to absorb. The idea is that you will temporarily reduce these foods or temporarily eliminate these foods so that you can gather an understanding of what's happening with your body.

[Jonathan Wolf]

And will, what are the sort of things that you would cut out if you were doing this?

[Dr. Will Bolsiewicz]

You may start with things like milk and ice cream, wheat, beans, lentils, even some fruit and veggies like onions and apples and garlic. Again, all temporary. But you can also start with a much more limited version where you would temporarily restrict dairy and gluten containing products.

[Jonathan Wolf]

And what about supplements or anything else that we can take for IBS instead of like effectively excluding things?

[Dr. Will Bolsiewicz]

So there's been mixed evidence, but there are some that stand out in terms of potentially being helpful. So one is peppermint oil. Peppermint oil seems to really help in terms of abdominal discomfort and bloating. The menthol seems to have a soothing effect on the small intestine. There was also a 2014 paper showing that probiotics can improve IBS symptoms. Now, in this paper, they said the quality of the existing studies is limited. And as a gastroenterologist, I would agree with that. Probiotics are not the solution for everyone, but when you find the right probiotic, it can actually be very helpful for many people. And the last thing that I would say is that I've had great success with some fiber supplements, specifically psyllium husk or soluble fiber supplements. Jonathan.

[Jonathan Wolf]

Amazing. So it's nice to know there's some things that one can try now away from dietary measures. I also heard that acupuncture can help.

[Dr. Will Bolsiewicz]

It's interesting, Jonathan. A 2009 clinical trial of 230 participants with IBS found that those who received acupuncture actually did better than those who did not. Another thing you could try is mindfulness. This can be very helpful to some people, and this could be as simple as doing breathing exercises. I've had great success as well, Jonathan, using something called cognitive behavioral therapy or cbt. Now, this is something I usually use in addition to medical treatments. And of course, we should mention that there are medications that are commonly used for ibs. Now, I'm not a fan of just medications. I think we should be including these other things, but there are some that are really effective. And something that's interesting is that we have sort of repurposed many of the medications that were developed to treat depression we are using to treat irritable bowel syndrome, but we use them at a much lower dose. So when it comes to medicines, once again, you have to make choices based upon the person's individual needs.

[Jonathan Wolf]

And so will what. If someone's listening to this, they've been diagnosed with ibs, they've changed their diet, they changed some of their treatments, but things are still not getting better.

[Dr. Will Bolsiewicz]

You know, this is such a big topic, and there's so much that we could talk about here, Jonathan, but one of the things that I would say is that if you have irritable bowel syndrome, or frankly, even if you don't, we should all be orienting our diet and lifestyle towards supporting the gut microbiome. Because ultimately the gut microbiome plays a central role in the development of IBS I think that we've made that clear in our conversation today. And therefore our solution should include centrally a focus on improving and elevating the gut microbiome. Now, there are some people that in particular I've taken care of through the years, Jonathan, who, like, they've literally tried everything. And these people are desperate and they're just not getting better. Their quality of life is in shambles. And when this is the case, typically my first approach is to ask the question, is this really ibs? Because if you can identify an alternative cause, that may be the solution to fixing the problem. That may be why you're not getting better. Another thing that people should consider is the power of the brain gut connection. Throughout my career, Jonathan, I've witnessed this so many times, where the connections between our digestive issues and our mood or having a history of trauma can actually be fueling these problems. So it's interesting, but sometimes the solution isn't actually just treating the gut. Sometimes the solution is also addressing that psychological factor that's holding you back.

[Jonathan Wolf]

So well, coming to the conclusion here is IBS mainly in our heads, as some people have suggested.

[Dr. Will Bolsiewicz]

Absolutely not. That's, to me, absurd as a gastroenterologist, but what we do know is that there is this brain gut connection that is really relevant to irritable bowel syndrome. And when we're approaching this issue, we have to start by looking at the symptoms that are used to diagnose ibs, follow the Room four criteria and make sure that those symptoms are not actually some other condition that it's masquerading as ibs. So we have to think about these other things like celiac disease or inflammatory bowel disease. Now, stress is a factor here, and there are links to anxiety. So let's bear in mind the power that exists between the gut and the brain and how they are interacting. And when it comes to developing our treatment strategies, ultimately, I sincerely believe that dietary modification should be a part of the approach for every single patient who has this issue, that we should strive to elevate and improve the health of our gut microbiome. But also when we need medicine or when we need supplements, we shouldn't be bashful about that. We should take advantage of those possibilities to improve our symptoms and our quality of life. And don't lose sight of these other things that can be beneficial, like diaphragmatic breathing, acupuncture, or cognitive behavioral therapy.

[Jonathan Wolf]

Well, thank you. And I can tell that we could have spent five times longer on this. I'm sure this is a topic we'll come back to in the future. If, based on today's program, you'd like to try Zoe's personalized nutrition program to improve your health, maybe manage your weight, you can get 10% off by going to joinzoe.com podcast I'm Jonathan Wolf.

[Dr. Will Bolsiewicz]

And I'm Will Bolshowitz.

[Jonathan Wolf]

Join us next week for another Zoe podcast.

[Zoe]

Last thing, a quick reminder that you can get 20% off Zoe membership, our personalised nutrition [e-mail] using code ZOE20. This exclusive Cyber Week offer ends on December 3rd, so head to zoe.com today. That's Zoe 20 for 20% off. See you next time.